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We hypothesized atopic dermatitis is associated with increased severity of eosinophilic esophagitis (EoE), defined as an increased rate of food impaction, esophageal stricture, or subepithelial fibrosis on biopsy in pediatric patients. METHODS: We performed a retrospective chart review of patients with a diagnosis of EoE seen at our clinic between January 1, 2016 and June 30, 2019. Of 273 charts surveyed, 196 patients were excluded, and 77 with confirmed EoE were included. RESULTS: Atopic dermatitis was found in 16 (21%) patients. Subepithelial fibrosis on esophageal biopsy was found in 32 (42%) patients, while food impaction was present in 13 (17%) patients, micro-abscesses found in 31 (40%) patients and esophageal strictures in 1 patient (1.36%). Of 16 patients with EoE and atopic dermatitis, sub-epithelial fibrosis was found in 4 (25%, p-value 0.119) patients while food impaction was found in 1 patient (6.25%, p-value 0.288). We found a statistically significant increased median eosinophil count on initial biopsy of the proximal esophagus in patients with concomitant atopic dermatitis (60 vs. 20, pvalue 0.011). There was also a statistically significant elevated median eosinophil count on initial biopsy regardless of location (proximal, mid-or distal esophagus), in patients with concomitant atopic dermatitis (65 vs. 40, p-value 0.005). CONCLUSIONS: While concomitant atopic dermatitis was not found to confer a higher degree of severity of EoE, elevated eosinophil counts on biopsy may require a more tailored management approach to achieve remission of disease. Further study is required, including success of treatments in this population.

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